Factors affecting age-appropriate timeliness of vaccination coverage among children in Lebanon [version 1; referees: 2 approved]

Background: The effect of immunization does not only depend on its completeness, but also on its timely administration. Routine childhood vaccinations schedules recommend that children receive the vaccine doses at specific ages. This article attempts to assess timeliness of routine vaccination coverage among a sub-sample of children from a survey conducted in 2016. Methods: This analysis was based on data from a cross-sectional multistage cluster survey conducted between December 2015 and June 2016 among caregivers of children aged 12-59 months in all of Lebanon using a structured survey questionnaire. The analysis used Kaplan–Meier curves and logistic regression to identify the predictors of age-appropriate immunization. Results: Among the 493 randomly selected children, timely administration of the third dose of polio vaccine, diphtheria-tetanus-pertussis (DTP)-containing vaccine and hepatitis B (HepB) vaccine occurred in about one-quarter of children. About two-thirds of children received the second dose of a measles-containing vaccine (MCV) within the age interval recommended by the Expanded Programme on Immunization (EPI). Several factors including socio-demographic, knowledge, beliefs and practices were found to be associated with age-appropriate vaccination; however, this association differed between the types and doses of vaccine. Important factors associated with timely vaccination included being Lebanese as opposed to Syrian and being born in a hospital for hepatitis B birth dose; believing that vaccination status was up-to-date was related to untimely vaccination. Conclusions: The results suggest that there is reason for concern over the timeliness of vaccination in Lebanon. Special efforts need to be directed towards the inclusion of timeliness of vaccination as another indicator of the performance of the EPI in Lebanon

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Popularizing Egyptian Nationalism: Colloquial Culture and Media Capitalism, 1870-1919

In Egypt, during the late nineteenth-early twentieth century, older, fragmented, and more localized forms of identity were rapidly replaced with new alternative concepts of community, which for the first time, had the capacity to collectively encompass the majority of Egyptians. The existing historiography however, places Egyptian nationalism exclusively within the realm of elite politics. Thus, this dissertation seeks to investigate the agency of ordinary Egyptians in constructing and negotiating national identity. The principal reason why the Egyptian urban masses are not well represented in the literature is the almost complete neglect of colloquial Egyptian sources. Indeed, I would contend that writing a history of modern Egypt without taking into account colloquial Egyptian sources is, by default, a top-down history and will at best provide only a partial understanding of Egyptian society.This study has several simultaneous objectives. The first is to highlight and feature the role and importance of previously neglected colloquial Egyptian sources--be they oral or textual--in examining modern Egyptian history. This, I argue, is crucial to any attempt at capturing the voice of "ordinary" Egyptians. The second objective is to document the influence of a developing colloquial Egyptian mass culture as a vehicle and forum through which, among other things, "hidden transcripts" of resistance and critiques of colonial and elite authority took place. And lastly, through the lens of colloquial mass culture, this study traces the development of collective Egyptian identity, and the strengthening of Egyptian national communality from the 1870s to the 1919 Revolution

Decolonize the Lens

Decolonize the Lens is a series of discursive events that brought together photographic experts and international scholars to reflect on rethinking the dominant narratives in the history of photography. Over the course of four webinar talks, guest speakers have looked at Egyptian and Northeast African visual cultures in both historical and contemporary settings. Decolonize the Lens brought into focus issues of politics and how photography has empowered the citizen/subject to bring about a richer understanding of difference. The series considers how typically Western approaches to visual history can be de-centered by histories of other senses, such as aural/sound histories. What emerges from our history if we listen to the past instead of looking at it through an allegedly objective photographic lens? Decolonize the Lens is a joint research project between faculty in Journalism and Mass Communication, the History departments and the Photographic Gallery.https://fount.aucegypt.edu/decolonize_the_lens_videos/1000/thumbnail.jp

Introduction to Special Section: The Un-Exceptional Middle Eastern City

This special section of City and Society is dedicated to de‐exceptionalizing the study of Middle Eastern cities. The introduction argues that the study of Middle Eastern cities has been constrained in its analytical and methodological focus by a genealogy shaped by a triad of regional exceptions–Islam, oil, and authoritarianism–and that the three pieces curated for this special section move beyond those constraints in important ways. Focusing on geographical places and time periods that have remained peripheral to the study of Middle Eastern cities, the three articles ethnographically historicize the planned and unplanned processes through which cities in the region transform to transcend a genealogy of exceptionalism and the constraints it has created. They highlight the global and local connections that shape these processes to offer new perspectives on the study of scale, verticality and sensoriums in the shaping of urban transformation around the globe. The section developed from a conference on Middle Eastern cities convened at Princeton University in May 2013